A summary of the recommendations follows below, for Scottish Government to take forward, working where appropriate with NHS Scotland, health boards and partner organisations. Further details around the recommendations and specific aspects that should be considered are provided in Section 5 of the report.

Recommendation 1

Consider the range of information needs highlighted by the participants throughout this piece of work:

• Ensure that patients receive all required information around process, practicalities, available support, and options. This needs to be provided enough in advance and should cover their journey from start to finish.
• Ensure this information is up-to-date, clear, appropriate and accessible, and that it is provided in a range of formats according to patients' needs. Consider initially focusing on aspects that participants highlighted are complex and not as easy to understand, for example around the "reasonable offer" of appointments.
• Ask patients about their preferred communication methods and ensure these are used.
• Provide a contact point to ensure patients know where to go to ask questions including if their condition deteriorates.
• Ensure communication is open and provides opportunities for a two-way dialogue.

Recommendation 2

Consider the findings in this report in order to improve the processes and communication around Patient Focused Booking, implied acceptance, referral to team rather than individual consultant, attending appointments out of area, reasonable offer of appointment, resetting the clock, and reasonable delay:

• Ensure timescales for the processes discussed are appropriate and take into consideration the needs and circumstances of individuals and groups. When mitigations or exceptions are in place, these need to be communicated clearly to patients.
• Ensure information around these processes and the terminology used is clear, easy to understand and communicated to patients appropriately, according to their needs.
• Ensure the processes are explained to patients further if needed, to ensure understanding of the processes and how they may affect their waiting journey.

Recommendation 3

Ensure the development and implementation of these processes is person-centred and does not unfairly impact individuals and groups:

• Consider how these processes can be more "human" and person-centred, for example, by taking patient needs and circumstances into account, ensuring that measures are not perceived as punitive, and patients are aware of their responsibilities and options. This could be for example, providing alternative ways for people to reschedule appointments if they are not able or prefer not to do this via telephone.
• Continue working on Equality Impact Assessments (EQIAs) for each of the processes discussed, to identify impacts on different groups and people with different characteristics. Address these impacts through putting mitigations in place. Continue to review the EQIAs as needed.
• Health boards to review national EQIAs and complete local EQIAs to identify local impacts. Local EQIAs should be informed by local engagement with user groups around these processes, to ensure all patients are being supported.

Recommendation 4

Consider further exploring, at a local level, the reasons why patients miss or don’t book appointments, in order to identify barriers for individuals and groups and put mitigations in place.

Recommendation 5

Ensure the processes and changes discussed in this work consider the 2012 NHS Scotland Charter of Patient Rights and Responsibilities:

• Consider how the patient rights and responsibilities outlined in the Charter are reflected in the processes discussed, and any changes required to ensure increased alignment.
• Consider working on increasing patient awareness and understanding around the Charter, including how information in the Charter is communicated and how this may be done more effectively to match the information needs outlined in Recommendation 1, such as alternative formats. This work could include engagement around the Charter to identify with the help of users how it can best be used by patients and communicated, and how to ensure patients understand how Waiting Times Guidance is aligned with the Charter.

Recommendation 6

Moving towards implementation of the Waiting Times Guidance, Scottish Government should liaise with NHS boards to ensure engagement is carried out with local communities to understand the changes that may directly affect them and their potential impact. This should be in conjunction with local EQIAs.